"The Case Against Breastfeeding"

This month's edition of The Atlantic Monthly features an article by Hanna Rosin entitled "The Case Against Breastfeeding."  Thanks to many of you for emailing me about it!

There are several pieces to the argument she presents, and they roughly follow the perspective of one school of feminist thought (you can read about different feminist perspectives on breastfeeding here):

1) The evidence of better health outcomes for breastfed babies is "thin."
2) Women in some communities feel a lot of pressure to breastfeed.
3) Breastfeeding "keeps women down," and is "a serious time commitment that pretty much guarantees that you will not work in any meaningful way."

I'm going to tackle the first one here, though I have some strong feelings about the others, especially the third. Breastfeeding mothers can't do meaningful work?  It's going to be hard to break that news to the many, many breastfeeding mothers I meet who are working as doctors, teachers, professors, and nurses.  And of course this argument assumes that being a parent is not "meaningful work."

But back to the "thin" evidence for breastfeeding.  I'd like to point out a few things about her argument:

1) The author says that there are so many methodological problems in the research as to undermine the credibility of health claims.  As evidence of this, she points to a meta analysis published in...1984.

I wonder why she didn't cite the 2007 U.S. Department of Health and Human Services (AHRQ) meta analysis, "Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries," which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding. The analysis graded each study for methodological quality.  The report states,

"We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis."

And while this topic wasn't raised in the article at all, the study found: "For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer...Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression."

2) The article argues that breastfeeding provides limited protection against infection because "they never get into the blood." Right.  That's because the components in milk prevent the pathogens from getting into the baby's bloodstream to begin with.  The antibodies in breastmilk coat the lining of the baby's intestine and are pathogen-specific - blocking the bad bacteria and leaving the good bacteria alone, based on messages from the mother's immune system.  The bad bacteria can't get in to the baby's tissues, and leaves the baby's body in its poop.  This is a more efficient form of infection protection, says Dr. Lars Hanson, in The Immunobiology of Human Milk, because when a virus or bacteria does enter tissues, it requires an inflammatory response which involves symptoms of infection (fever, for example) and a higher energy requirement. 

3) But beyond this site-specific immune protection, there is the overall development of the baby's immune system.  Think of it this way: your baby's body is taking notes about what your milk fights in its system, and is remembering it for the next time it encounters that pathogen.  That's called active immunity.  It does this in part through memory T cells, through cytokines and chemokines, which do enter the baby's system through gut, and regulate activation of the immune system, and through other pathways. There are many more ways in which breastfeeding protects babies, but I don't have space for them here. 

I did find a couple of things to agree with in her article:  that there is irony in the fact that the movement to take back infant feeding from the medical establishment is now justified on the basis of medical research; and that women feel trapped between health recommendations and the reality of maternity leave policy in this country.

But all in all, I found this article to be a very selective reading of the research, with comments reflecting a highly specific experience of American motherhood, with a dollop of judgement on top.

If you're like me, this article raised some pretty strong feelings.  I'm going to encourage all of us to be respectful in our comments here.  However you view this article, try to address the arguments, not the person making them, please.

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